Provider Demographics
NPI:1821129578
Name:CERNA, MIGUEL E
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:E
Last Name:CERNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19024 SHERMAN WAY
Mailing Address - Street 2:#205
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2676
Mailing Address - Country:US
Mailing Address - Phone:818-470-6288
Mailing Address - Fax:
Practice Address - Street 1:6305 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401
Practice Address - Country:US
Practice Address - Phone:818-908-4999
Practice Address - Fax:818-908-0123
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner